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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : CO 2 1 A9e< Sampling Date : 7—�0 <br /> Sate : / b Pro3ect No. : <br /> /t-'' G ���O /Z/�� Well Designation• <br /> O 'o t <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no , see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) * <br /> Well cover type: 8 " UV 12 " UV 12" EMCO 8" BK <br /> 1211 BK 1211 DWP 12 " CNI 3 6" CNI Other_ r lL <br /> General condition of wellhead assembly. Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer `Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with. Disposable bailer:--5-"f— Teflon bailer: <br /> Well Diameter. 2" 4'1-4 6" 8" <br /> Purge Vol Multiplier: 0 16 0 65 1 . 47 2 61 gal/ft <br /> Initial Measurement Rechar aeasurement <br /> Time r <br /> ,� �O Time: Calculated purge. ? <br /> Depth of well . Depth to water: 4 Actual purge _ <br /> Depth to water . �- 6 , d <br /> Start purge : S Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 47 ��" � 6 �3 0 9 0 7 /6 ---� � <br /> 13 � _ ( yd2 7 - l / <br /> Sample appearance: cvi Lock• �E2 <br /> Equipment replaced; (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap; Lock , 3753 : 7/32 Allenhead . <br /> 4 " Locking Cap : Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap : Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />